Sales data in China indicate that slim cigarette consumption has increased dramatically over the last few years. This study examined who smoked slim cigarettes and the reasons for adopting these new products. A survey of an online panel from 19 Chinese cities was conducted from October 2018 to April 2019 with 20,055 members aged 16 and older. Among the 31.7% [95% confidence interval (CI) = 30.1-33.4] of panel members who reported currently smoking, 37.7% (95% CI = 34.8-40.5) smoked slim cigarettes. Among smokers, women were significantly more likely to smoke slim cigarettes than men [56.5% (95% CI = 50.8-62.2) vs. 35.5% (95% CI = 32.8-38.1)]. Smokers with a bachelor's degree were more likely to smoke slim cigarettes than those without [41.3% (95% CI = 38.1-44.4) vs. 33.1% (95% CI = 30.0-36.1)]. Most slim cigarette smokers were dual smokers [77.7% (95% CI = 75.3-80.1)], smoking both regular and slim cigarettes. Among dual smokers, 97.5% (95% CI = 96.7-98.3) started smoking regular cigarettes before slim cigarettes. Of the many reasons given for smoking slim cigarettes, 37.0% (95% CI = 34.3-39.7) directly related to harm reduction with another 10.1% (95% CI = 8.4-11.7) reporting their reason as wanting "to reduce consumption of regular cigarettes," a plausible indication of harm reduction. These findings suggest strong interest in harm reduction among the current Chinese smoking population and that the popularity of slim cigarettes is likely to increase, with the more educated as the early adopters. Given the absence of any evidence that these products actually reduce harm, it is urgent that the public health community be on high alert in order to avoid repeating the sad history of low-tar cigarettes, when a supposed harm-reduction product misled the field of tobacco control.

BACKGROUND

Health authorities across nations differ markedly on their position regarding electronic cigarettes. For example, the Royal College of Physicians in the United Kingdom promoted e-cigarettes as a harm-reduction alternative to cigarettes, whereas the United States Centers for Disease Control and Prevention warned against the use of e-cigarettes.

OBJECTIVE

This study tests the effects of these different policy messages on the public’s perception of e-cigarettes.

METHODS

Participants (N=20,055) were sampled from an online panel with members from 19 major Chinese cities, and were randomized into three groups. Group 1 received brief messaging on e-cigarettes equivalent to the UK position, Group 2 received messaging equivalent to the US position, and Group 3 served as a control.Harm of cigarettes and e-cigarettes were rated on a 1–10 scale. Cigarettes smokers were asked if they intended to use e-cigarettes in a future quit attempt.

RESULTS

The group exposed to the US message rated e-cigarettes as significantly more risky than the control group, 5.87 (95%CI, 5.81-5.93) vs. 5.49 (5.43-5.55). The UK message group had a similar rating to the control, 5.42 (5.36-5.48). A lower percent of smokers in the US message group, 53.9% (51.8-56.0), intended to use e-cigarettes in future attempts to quit smoking than the control group, 60.1% (58.0-62.2), which was similar to that of the UK message group, 60.3% (58.3-62.4).

CONCLUSIONS

Messages from health authorities that cast e-cigarettes chiefly in a negative light could significantly increase the perceived risks of e-cigarettes and decrease smokers’ intentions to use e-cigarettes to quit smoking. In addressing the risk of e-cigarettes, policymakers should consider the net effect of a policy so as to maximize its potential to save lives.